iTriage App: Review

The artistry behind hypochondria is the deft speed at which someone can go from noticing a benign symptom to believing they have a life-threatening disease. Whereas most other mental trains might stop over at stations like “mild concern” or “statistical odds calculations”; the hypochondriac’s mind can race straight to “euthanasia” faster than you can say: “But you don’t even have a prostate.” In that sense the iTriage app is to a hypochondriac what a drunk technician is to a nuclear power station.

iTriage is a very well thought out and comprehensive app that maps all the things that could possibly be wrong with you before providing treatment tips and advice. The first thing you see when you open it is a racially neutral version of Da Vinci’s Vitruvian man—or an Asian woman. You are then meant to tap on a part of the body that is worrying you. A number of complaints are listed to choose from, which in turn lead to a section with possible causes. In short: the time it took hypochondriacs to get from slight chest pain to angina has now been reduced even further. The whole process has gone digital and hand-held.

Ignorance, one of the few factors that used to keep a lid on hypochondriac hyperbole, is effectively eliminated with the iTriage app. Because most people’s medical lexicon used to be relatively limited, whenever they had a medical complaint they would assume it was something they knew, like cancer. This app puts an iron-man suit on their paranoia by providing drop-down menus that cascade into a rabbit hole of unknown diseases. Got lower abdominal pain? Sure it could be appendicitis, but it also could be prostatitis, inguinal hernia, Crohn’s disease, somatization disorder, cholelithiasis and so on and so forth. To be fair, iTriage does divide possible causes into “common” and “uncommon” sections but it’s very easy for the “uncommon” column to draw your attention like a car wreckage.

iTriage is the brainchild of two emergency room physicians, Drs Peter Hudson and Wayne Guerra. According to their about section, they developed the app in response to a growing need for patients to have more actionable healthcare information in their hands. Its recommendations are based on thousands of symptoms, health conditions and medical procedures. It also offers a directory of hospitals, urgent care centres, retail clinics and help lines. A particularly nifty feature is the videos that it suggests, making the app engaging even to injured millennials. I’ve been having slight ear irritation over the past few days. So I went through the steps on the app. It led me to the conclusion that I must have swimmer’s ear. It gave me links me to a youtube video of a doctor in Buffalo, New York. He talked me through my treatment options, which happened to include home remedies. According to him, rinsing my ear out with a solution made up of equal parts vinegar and water could help.

The user experience with the application is quite pleasant. Information comes up swiftly. The design is logical and intuitive. It also has genuinely thoughtful additions such as an age sliding scale that allows you to concentrate on conditions that might apply to your age group. Unfortunately the localization features are not as satisfying in Germany. It just wasn’t that good at identifying which medical facilities are around me.The service seems to be primarily for an American market.

My biggest concern with the app is not with the functionality or the execution, both are exemplary. Instead I’m worried about how this kind of app will change us, as a species. Marshall McLuhan published his seminal book in 1964 called The Medium is the Message. In it he describes how the media we use change our psychology and eventually our sociology. For example, he argues that the introduction of television negatively affected our ability to enter into in deep thought because TV conditions us to only metabolize short, visualized bits of information. In that respect, yes this kind of app might empower people to make more informed medical decisions. But it also could make know-it-all patients more insufferable to the poor doctors who have to treat them. As the old saying goes: “An expert is anyone who has read one book.” How much more self-assured will the experts be who come with world-wide-web turbo boosts?

After using an app like this recently I went to the doctor because of pain in a joint. Gout! I was sure of it. I walked into the consultation room with the resoluteness of a woman who has circumstantial evidence that her husband is cheating. I questioned the doctor as much as he questioned me. “Do you really think x-rays are necessary… that won’t do much to tell us if the pain is caused by acidity… as is consistent with…say, gout?”

While he went about his examination I was coiled, ready to pounce on any evidence that confirmed my hypothesis. The encounter was altogether confrontational and conspiratorial at the same time. “Why is this guy being such a gout denialist?” I thought. I grew increasingly skeptical when he veered off my D.I.Y diagnosis and ordered the x-rays anyway. After speaking to some other doctors I found out that gout is indeed a very unlikely diagnosis for someone my age, especially given the details of how my symptoms presented. The doctor was right because: first of all, he’s a doctor, and second of all, he’s been doing his job every day for years. I, on the other hand, was a one-book-expert.

I wouldn’t consider myself to be much of a hypochondriac (that’s what they all say, right?). But won’t apps like this exaggerate the parts of ourselves that crave both security and drama, turning us into hypochondriacs? What’s more, the knowledge we get through them is not tempered by years of experience or even an understanding of bell curve distributions. In that sense, even though the the app is good at what it is good at, I’m not sure I would recommend it. Ironically, hypochondria is not on the list of conditions it can help you treat.

COMMENTS

Syeeda Sanchita Farruque

Great article!

Interestingly, iTriage was one of the health apps that was discussed during an experimental evaluation we had to review during our health informatics studies. The review process looked at issues around app safety, quality, whether there was robust clinical evidence to back its purpose, usability and other factors that simply didn’t look at whether the app should even exist!

I completely agree with you – whilst helping patients empower themselves by using tools to support them and their health, providing them with a tool that pushes them into the spectrum of obsessiveness is not a path that ought to have been traversed!

Perhaps formulating the triaging to: “Possible mild conditions – do these simple things” vs “if symptoms are persitent or you are worried: go to your doctor”, rather than thrusting a differential diagnosis in their faces without also offering the weight of judgement that comes from working on treating illnesses daily.